This invention pertains to a certain aspect of cardiology, and in particular, to methodology and associated system apparatus that are employable with respect to pacemaker patients to obtain useful heart-sound and ECG-electrical information which enables a very accurate, and graphically intuitive, assessment of a patient's hemodynamic status. The invention also provides an important feedback opportunity for adjusting such a patient's current medical treatment, including the making of a pacemaker operational adjustment, in a manner aimed at improving that patient's hemodynamic condition. With the system and methodology of the invention in operation, the results of such feedback can be viewed immediately in real time.
The invention thus addresses an important area of cardiology wherein it is considered to be very useful and important to be able, under real-time, result-observation conditions, to fine-tune a pacemaker-patient's hemodynamic behavior and condition. The terms “pacemaker” and “pacemaker patient” are employed herein in relation to patients and implant equipment involving cardiac resynchronization therapy.
In this context, it is now very well recognized that, in addition to the heart-condition-assessment value of possessing accurately gathered and clearly readable ECG electrical information, is also extremely valuable to obtain, for accurate viewing, simultaneously occurring heart-sound information relating especially to the heart sounds known as the S1, S2, S3 and S4 heart sounds. As those skilled in the art recognize, there are various kinds of conditions which can make difficult the accurate acquisition and identification of clearly confirmable heart sounds, often because of various “other conditions” which tend to obscure accurate heart-sound information. One of these troublesome, “obscuring” conditions exhibits itself sometimes in the presence of pacemaker operation in the form of phrenic nerve stimulation. More specifically, too vigorous a pacemaker ventricular pacing pulse, an issue in and of itself, can produce such stimulation which, in turn generates an acoustic artifact that can “confuse” a heart-sound diagnostic algorithm in a way which mars accurate heart-sound investigation.
The present invention, in the context of improving heart-sound collection and display for hemodynamic status assessment and adjustment in the realm of pacemaker operation, takes particular aim at this circumstance and these issues—namely, at the above-mentioned, unwanted events involving a subject whose heart has been equipped with a pacemaker. It does so, as will be seen, with unique methodology which leads to very accurate and reliable gathering and intuitive presentation of both ECG-electrical and heart-sound acoustic information, with appropriate processing being applied to the gathered information to assure a high level of certainty regarding acquired audio data containing heart-sound information in categories that are important to the assessment and management of a subject's hemodynamic condition. This presentation capability of the invention is, as will be seen, extremely useful in the world of pacemaker patients.
Describing features of the invention in the subject “pacemaker” setting, the present invention operates to recognize potential “phrenic nerve stimulation” problems, and as such, provides signal-collection and signal-processing circuitry operation and methodology which responds to real time pacemaker operation in a manner that effectively (a) prevents the mentioned heart-sound confusion issue from surfacing, (b) informs a physician, clinician, etc. that a pacemaker's ventricular pacing pulse may need to be adjusted, and (c) opens a significant door for the improved gathering and processing accuracy, and the presentation, of heart-sound information leading to accurate assessment (indeed “picturing”) of a subject's hemodynamic condition.
Additionally, the invention addresses the utility of employing such carefully gathered and processed information in a manner enabling feedback control to be applied to an operating pacemaker so as to enable the physician, or other party, (working with a particular pacemaker subject) to fine-tune the interrelated operations of the subject's heart and the associated pacemaker so as to improve that subject's hemodynamic condition.
As an important aside feature, medical treatment feedback, other than that relating to pacemaker operation, is also encouraged, promoted, and made available, based on operation of the invention, for improving, and for observing feedback results in real time regarding, a patient's hemodynamic condition.
The invention further features the creation of a unique, visual, graphical presentation (with geometric elements) of gathered ECG-electrical and heart-sound acoustic information, in a real time manner, and in such as fashion that the employment of feedback to control various medical treatment and/or pacemaker operations so as to improve hemodynamic behavior can be seen immediately on a very intuitive visual representation of the associated subject's actual, then-existent, hemodynamic condition and behavior.
These and various other features and advantages which are offered by the present invention will become more fully apparent as the description which now follows is read in conjunction with the accompanying drawings.